Superman is afraid of just one thing—kryptonite. This small piece of his home world can put him on his knees, heart pounding, weak, faint. Fears and phobias too are often rooted in childhood experiences and can have debilitating effects on people throughout their lives. An extremely fruitful way of dealing with fears is to face them in small, manageable steps. Called “exposure therapy” this skill is backed by solid research which shows it to be extremely effective, with long-lasting results. And, there are a few ways you can make exposure even better.
Exposure therapy involves confronting fears in a safe environment, and in so doing both increasing your tolerance to the trigger and decreasing reactivity. Fear triggers the fight, flight, or freeze response, a limbic system survival mechanism common to all higher organisms. With anxiety and specific phobias, the fear sensor has been turned up way too high and a warning is sounded when there is no danger. The result is that life becomes about avoiding the fear, a much less enjoyable way of being. Anxieties and phobias reinforce a closed behavioral loop—a “what if it really happens” trap that prevents you from doing something for fear of triggering the fear; yet avoidance only reinforces the fear. Directly facing your fears head-on is often not effective either, for it can strengthen the fear response; if the intensity of powering your way through a fear is too high, the fear of facing such a high intensity again increases the anxiety. (A good example of this: in May of 2014 an Oregon man fainted while driving through a tunnel and holding his breath, causing an accident.) The solution is gradual exposure with conscious self-management.
Exposure has been shown to turn off the fear response and increase the ability to better deal with fear triggers in the future. Researchers at Tufts University found that exposure switches off the neurons responsible for fear, located in the amygdala, by activating “fear brakes,” other neurons responsible for shutting down the fear response. Exposure both silences fear neurons and remodels how the brain responds to future fear—affecting the perisomatic synapse, connections between neurons that allow one group of neurons to silence another group (1). Although it may seem intimidating to face your fears, exposure works extremely well; the key is to use small steps.
Exposure is a stepped process of confronting a fear and its triggers in small pieces until eventually you can handle the entire trigger. Exposure works on most fears, including social anxieties, fear of heights, the dark, insects, animals, and needles, and more.
How to use Exposure Therapy to Conquer your Fears:
- Choose a Target: You may have several anxieties or fears you wish to deal with. Setting too many goals at one time can detract from the effectiveness of exposure and can activate a self-blame and fear cascade, reinforcing the very phobias you are trying to overcome. By choosing one target and working on it conscientiously, you will better develop the skills and self-confidence to tackle the next one.
- Create Micro-Goals: Divide each fear you are facing into smaller steps; 10 is a good number. Like climbing a ladder, start at the bottom step and slowly work your way up over a period of days or weeks. For example, if you have a fear of getting a vaccination needle, step one may be looking at a needle, step two touching it (with sharps removed), etc. You should feel some anxiety in working through each micro-step but not enough that you will shut down. Self-soothing skills are essential as you expose yourself to the fear:
- Self-Soothe: Fear is a physiological response. By taking active control of your physiology while doing exposure work you help turn off the fear response. Better yet, practice self-soothing before you begin exposure. Like a fire-drill, you will then know how to calm yourself when fear hits. Self-soothing can include diaphragmatic breathing, progressive muscle relaxation (slowly and deeply tensing and relaxing each muscle group, one at a time), visualizing a calming scene, yoga, slow stretches, or other calm and focused physical activity. Mindfulness helps too (see below). Whatever your routine, perform it for at least 3 minutes and then return to exposure work.
- Mindfulness: Mindfulness is a quality of awareness you can cultivate with practice. It can help with exposure by putting your attention on something other than the anxiety. Simple Mindfulness exercise: Find 3 things to focus on round you (not tied to the anxiety). A tree, your breathing, the color of the cars on the road, the sky, etc. Note the quality, colors, feelings; experience each thing slowly, breathing.
- Climb the Exposure Ladder: This is the hardest step—performing the tasks on your anxiety exposure ladder. If a step seems too hard, perform it first in your mind or watch a video of someone doing the step, and self-soothe. The only way to make progress is to take each step. Remember Laozi’s advice: “The journey of a thousand miles begins with a single step.”
- Deal with Anxiety-based Thoughts: A basic tenet of Cognitive Behavioral Therapy is recognizing when thoughts are anxiety-fueled and putting your attention instead on realistic thoughts. “What if I really do have a heart-attack and no hospital is close by” is an anxiety-based thought. “My heart works as it should. I can drive to work and use my tools to cope” is a realistic thought. By repeatedly doing this exercise you train yourself to identify with realistic thoughts.
- Reward Yourself: When you reach each step, give yourself a small reward; when you reach a major goal (the top of a ladder), give yourself a bigger reward. Remember the difference between a reward and a bribe: A bribe comes before you perform the task (and a bribe is ineffective); a reward follows completion of a task. The healthier the reward, the better you’ll feel about yourself.
- Talk Gently to Yourself: Set yourself up for success by using compassionate self-talk versus self-shaming or self-guilt (and the procrastination & evasion that results from berating yourself). “I am taking the steps I need to do to face my fears,” “I will self-manage and try again,” are examples of compassionate self-talk.
- Maintain your Goals: Once a fear or anxiety goal is reached, you may need to periodically repeat exposure to maintain your gains. This is true for anything in life; “practice maintains perfect.”
- Express your Fears: What can make exposure more effective and personal is by adding creative expression. This may include drawing or writing the story of your fear. This is not a way to justify or reinforce a fear but to paint the background for your exposure work and to activate creative thinking resources. The more areas of your brain you engage, the better the result.
Several years ago I worked with a dancer who had a fear of spiders. Part-way through her exposure work she came up with the idea of a spider-themed expressive dance. Excellent exposure in itself, her dance involved the talented, creative parts of her personality. She even performed her dance at a children’s workshop months later.
Exposure therapy is about setting goals and breaking those goals down into bite-size, doable pieces (and rewarding yourself when you complete each step); a useful strategy for any task in life. In therapy, I help people deal with anxiety through exposure and other tools. Contact me for more information about becoming the superman or superwoman you are meant to be.
References: 1. Trouche, S., Sasaki, J.M., Tu, T., Reijmers, L.G. (November 20, 2013). Fear extinction causes target-specific remodeling of perisomatic inhibitory synapses. Neuron, 80 (4).